Post-Operative Iron Carboxymaltose May Have an Effect on Haemoglobin Levels in Cardiothoracic Surgical Patients on the ICU - an Observational Pilot Study about Anaemia Treatment with Intravenous Iron

Peters, F. P. J.; Eveslage, Maria; Gallitz, Inka; Wempe, Carola; Meybohm, Patrick; Aken, Hugo K. Van; Steinbicker, Andrea U.

doi:10.1159/000481143

Cited by 14 publications

(6 citation statements)

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“…were RCTs (32 920 participants) and 8 were NRSs (7146 participants). [185][186][187][188][189][190][191][192] of bias assessments, of NRSs that reported on outcomes of infection is provided in eAppendix 2 and eTables 3 and 4 in the Supplement.…”

Section: Study Characteristicsmentioning

confidence: 99%

Risk of Infection Associated With Administration of Intravenous Iron

et al. 2021

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IMPORTANCEIntravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain. OBJECTIVE To examine the risk of infection associated with intravenous iron compared with oral iron or no iron. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform. STUDY SELECTION Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility. DATA EXTRACTION AND SYNTHESIS Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection. MAIN OUTCOMES AND MEASURESThe primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.RESULTS A total of 154 RCTs (32 920 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.17; 95% CI, 1.04-1.31; I 2 = 37%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g/dL; 95% CI, 0.50-0.64 g/dL; I 2 = 94%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.93; 95% CI, 0.76-0.89; I 2 = 15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay. (continued) Key Points Question In patients who require treatment with intravenous iron, what is the evidence that this intervention increases the risk of developing a new infection? Findings In this systematic review and meta-analysis of 154 randomized clinical trials that included 32 920 participants, intravenous iron was associated with an increased risk of infection. Meaning The results of this study suggest that, despite broad advocacy in clinical guidelines, intravenous iron may increase the risk of infection, which must be balanced with the potential benefits of treating anemia and reducing blood transfusion requirements.

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Section: Study Characteristicsmentioning

confidence: 99%

Risk of Infection Associated With Administration of Intravenous Iron

et al. 2021

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“…were RCTs (32 920 participants) and 8 were NRSs (7146 participants). [185][186][187][188][189][190][191][192] Two RCTs 47,106 were analyzed as 2 separate studies each. A descriptive summary, including study characteristics and risk of bias assessments, of NRSs that reported on outcomes of infection is provided in eAppendix 2 and eTables 3 and 4 in the Supplement.…”

Section: Study Characteristicsmentioning

confidence: 99%

Risk of Infection Associated With Administration of Intravenous Iron: A Systematic Review and Meta-Analysis

et al. 2021

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“…There is a paucity of studies that treat preoperative iron-deficiency anemia with just iron. One prospective observational study demonstrated an increased hemoglobin level in pretreated anemic patients, 9 but a small RCT of only 50 patients did not. 10 Therefore, it is difficult to confidently state that the direct treatment of iron-deficiency anemia before cardiac surgery with iron alone will result in improved outcomes, but it is clear that the treatment of anemia is warranted in the elective surgical patient.…”

Section: Risk Assessment For Treatment Of Anemiamentioning

confidence: 99%